Poincaré plot is one of the important techniques used for visually representing the heart rate variability. It is valuable due to its ability to display nonlinear aspects of the data sequence. However, the problem lies in capturing temporal information of the plot quantitatively. The standard descriptors used in quantifying the Poincaré plot (SD 1, SD 2) measure the gross variability of the time series data. Determination of advanced methods for capturing temporal properties pose a significant challenge. In this paper, we propose a novel descriptor "Complex Correlation Measure (CCM)" to quantify the temporal aspect of the Poincaré plot. In contrast to SD 1 and SD 2, the CCM incorporates point-to-point variation of the signal. First, we have derived expressions for CCM. Then the sensitivity of descriptors has been shown by measuring all descriptors before and after surrogation of the signal. For each case study, lag-1 Poincaré plots were constructed for three groups of subjects (Arrhythmia, Congestive Heart Failure (CHF) and those with Normal Sinus Rhythm (NSR)), and the new measure CCM was computed along with SD 1 and SD 2. ANOVA analysis distribution was used to define the level of significance of mean and variance of SD 1, SD 2 and CCM for different groups of subjects. CCM is defined based on the autocorrelation at different lags of the time series, hence giving an in depth measurement of the correlation structure of the Poincaré plot. A surrogate analysis was performed, and the sensitivity of the proposed descriptor was found to be higher as compared to the standard descriptors. Two case studies were conducted for recognizing arrhythmia and congestive heart failure (CHF) subjects from those with NSR, using the Physionet database and demonstrated the usefulness of the proposed descriptors in biomedical applications. CCM was found to be a more significant (p = 6.28E-18) parameter than SD 1 and SD 2 in discriminating arrhythmia from NSR subjects. In case of assessing CHF subjects also against NSR, CCM was again found to be the most significant (p = 9.07E-14). Hence, CCM can be used as an additional Poincaré plot descriptor to detect pathology.

This paper presents the design of a fully integrated electrocardiogram (ECG) signal processor (ESP) for the prediction of ventricular arrhythmia using a unique set of ECG features and a naive Bayes classifier. Real-time and adaptive techniques for the detection and the delineation of the P-QRS-T waves were investigated to extract the fiducial points. Those techniques are robust to any variations in the ECG signal with high sensitivity and precision. Two databases of the heart signal recordings from the MIT PhysioNet and the American Heart Association were used as a validation set to evaluate the performance of the processor. Based on application-specified integrated circuit (ASIC) simulation results, the overall classification accuracy was found to be 86% on the out-of-sample validation data with 3-s window size. The architecture of the proposed ESP was implemented using 65-nm CMOS process. It occupied 0.112-mm ² area and consumed 2.78-μW power at an operating frequency of 10 kHz and from an operating voltage of 1 V. It is worth mentioning that the proposed ESP is the first ASIC implementation of an ECG-based processor that is used for the prediction of ventricular arrhythmia up to 3 h before the onset.

Obstructive sleep apnea or hypopnea causes a pause or reduction in airflow with continuous breathing effort. The aim of this study is to identify individual apnea and hypopnea events from normal breathing events using wavelet-based features of 5-s ECG signals (sampling rate = 250 Hz) and estimate the surrogate apnea index (AI)/hypopnea index (HI) (AHI). Total 82 535 ECG epochs (each of 5-s duration) from normal breathing during sleep, 1638 ECG epochs from 689 hypopnea events, and 3151 ECG epochs from 1862 apnea events were collected from 17 patients in the training set. Two-staged feedforward neural network model was trained using features from ECG signals with leave-one-patient-out cross-validation technique. At the first stage of classification, events (apnea and hypopnea) were classified from normal breathing events, and at the second stage, hypopneas were identified from apnea. Independent test was performed on 16 subjects' ECGs containing 483 hypopnea and 1352 apnea events. The cross-validation and independent test accuracies of apnea and hypopnea detection were found to be 94.84% and 76.82%, respectively, for training set, and 94.72% and 79.77%, respectively, for test set. The Bland-Altman plots showed unbiased estimations with standard deviations of plusmn 2.19, plusmn 2.16, and plusmn 3.64 events/h for AI, HI, and AHI, respectively. Results indicate the possibility of recognizing apnea/hypopnea events based on shorter segments of ECG signals.

Objective To assess clinical profiles of patients with type 2 diabetes in the United Arab Emirates (UAE), including patterns, frequencies, and risk factors of microvascular and macrovascular complications. Research design and methods Four hundred and ninety patients with type 2 diabetes were enrolled from two major hospitals in Abu Dhabi. The presence of microvascular and macrovascular complications was assessed using logistic regression, and demographic, clinical and laboratory data were collected. Significance was set at p<0.05. Results Hypertension (83.40%), obesity (90.49%) and dyslipidemia (93.43%) were common type 2 diabetes comorbidities. Most of the patients had relatively poor glycemic control and presented with multiple complications (83.47% of patients had one or more complication), with frequent renal involvement. The most frequent complication was retinopathy (13.26%). However, the pattern of complications varied based on age, where in patients 65 years old. Low estimated glomerular filtration rate in combination with disease duration was the most significant risk factor in the development of a diabetic-associated complication especially for coronary artery disease, whereas age, lipid values and waist circumference were significantly associated with the development of diabetic retinopathy. Conclusions Patients with type 2 diabetes mellitus in the UAE frequently present with comorbidities and complications. Renal disease was found to be the most common comorbidity, while retinopathy was noted as the most common diabetic complication. This emphasizes the need for screening and prevention program toward early, asymptomatic identification of comorbidities and commence treatment, especially for longer disease duration.